Provider Demographics
NPI:1225549991
Name:ANSARI, TAWFIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:TAWFIQ
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCARLET OAK CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-8971
Mailing Address - Country:US
Mailing Address - Phone:919-479-9078
Mailing Address - Fax:919-479-9078
Practice Address - Street 1:5 SCARLET OAK CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-8971
Practice Address - Country:US
Practice Address - Phone:919-479-9078
Practice Address - Fax:919-479-9078
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36327-20207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine